巨细胞病毒性视网膜炎的眼底荧光素血管造影表现

目的:探讨获得性免疫缺陷综合征(AIDS)患者所患巨细胞病毒(CMV)性视网膜炎的眼底荧光素血管造影(FFA)表现.方法:对37例确诊为AIDS患者进行临床视力、眼底及FFA检查.结果:10例(20眼,27.0%)未发现异常,27例(41眼,55.4%)合并CMV性视网膜炎,其中单眼发病13例,双眼发病14例.FFA发现最多为视网膜血管炎38眼(92.7%),其次视盘水肿18眼(43.9%)、黄斑水肿11眼(26.8%)、视网膜毛细血管无灌注8眼(19.5%),视网膜萎缩灶7眼(17.1%),视网膜增殖性改变5眼(12.2%)等.结论:FFA对于CMV性视网膜炎所表现的视网膜血管炎、视盘水肿、黄斑水肿、视网膜毛细血管无灌注等有重要的诊断价值,同时在鉴别诊断中亦有重要作用.     

Fomivirsen治疗巨细胞病毒性视网膜炎

根据Vitravene研究小组的三项试验报道显示,反义低聚核苷酸fomivirsen可适当安全有效地治疗艾滋病患者的巨细胞病毒(CMV)性视网膜炎。巨细胞病毒性视网膜炎是艾滋病患者最为常见的机会性感染之一。     

193例HIV/AIDS合并视网膜炎的临床特征分析

目的 分析人类免疫缺陷病毒(human immunodeficiency virus,HIV)/获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者视网膜炎发生的临床特征及治疗后反应.方法 收集2015-2017年在重庆市公共卫生医疗救治中心住院的193例HIV/AIDS合并视网膜炎的患者,男性156例,女性37例,年龄(43.9±11.9)岁;分为巨细胞病毒视网膜炎(cytomegalovirus retinitis,CMV R)组和HIV微血管病(HIV microangiopathy,HIV M)组,对其临床资料、检测指标、眼科检查结果及抗病毒治疗效果进行回顾性分析.结果 HIV/AIDS合并有视网膜炎的患者,CD4+T细胞计数明显低于非视网膜患者,而HIV RNA显著高于非视网膜患者(t=5.6、-2.3,P＜0.05).HIV M和CMV R无眼科症状的患者分别占44.4％、41.7％;CMV R以双眼病变为主,占77.4％;视网膜炎的总发生率为45.7％,并随着CD4+T细胞的降低逐渐增高,CD4+T细胞＜200个/μL时视网膜炎的发生率为30％,CD4+T细胞＜ 50个/μL时视网膜炎发生率最高,达58.6％.人巨细胞病毒DNA(human cytomegalovirus DNA,HCMV DNA)阳性的视网膜炎患者给予抗巨细胞病毒治疗后HCMV DNA转阴率在70％以上;CMV R视力恢复及病灶吸收率明显高于HIV M患者(x2=9.526、24.206,P＜0.05).结论 HIV/AIDS患者发生视网膜炎的风险与CD4+T细胞水平密切相关,呈负相关性;对于CD4+T细胞＜200个/μL的患者推荐行眼科相关检查,对于CD4+T细胞＜50个/μL的患者建议常规开展眼科相关检查;全身抗巨细胞病毒治疗可有效控制病毒,改善眼部症状,提高生活质量.     

艾滋病合并巨细胞病毒性视网膜炎的诊断与治疗

目的探讨艾滋病（AIDS）合并巨细胞病毒（CMV）性视网膜炎的临床特征及相应的治疗。方法回顾性分析211例（422眼）AIDS患者的临床资料,包括发病时间、视力、眼前节、眼底检查、荧光素眼底血管造影（FFA）及外周血CD4＋T淋巴细胞检测结果,其中47例（63眼）合并CMV性视网膜炎,确诊后均足量全身使用抗病毒药更昔洛韦、地塞米松、抗凝药及改善循环药物,根据病情行球后注射等。结果初诊时,发病1周内者治疗有效率100%;发病1～2周者治疗有效率93.8%;发病2周后～4周者治疗有效率86.7%;发病4周以上者治疗有效率66.7%。结论 CMV性视网膜炎患者早期诊断是治疗的关键,早期全身足量抗病毒（CMV）药物治疗是基础,球后注射是有效的治疗方法。     

艾滋病合并巨细胞病毒性视网膜炎3例报告

1 病例资料 2002年1月至2006年12月,南京市第二医院共收治AIDS患者58例,其中3例合并巨细胞病毒(CMV)性视网膜炎,占5.2%.男2例,女1例;年龄分别为27、28、48岁.所有患者诊断均符合艾滋病诊疗指南诊断标准[1].感染途径:经血传播1例,性途径传播2例.临床表现:主要症状为眼前有漂浮物、视力模糊、视力下降;眼底检查发现视网膜血管炎、出血、渗出、不规则的黄白色颗粒等.     

巨细胞病毒感染与胆道闭锁发病的关系

目的研究胆道闭锁患儿巨细胞病毒的感染率,探讨巨细胞病毒感染与胆道闭锁发病之间的关系.方法对15例经过手术或者胆道造影等证实为胆道闭锁的患儿进行血清学的CMV-IgM以及CMV-IgG检测;同时应用实时荧光定量PCR法对此15例患儿的肝脏活检标本以及9例尸检婴儿的肝脏组织进行CMV DNA检测,检测巨细胞病毒的感染率.结果15例胆道闭锁患儿中,应用ELISA法对血液标本进行检测,仅CMV-IgG阳性3例(20%),CMV-IgG及CMV-IgM均阳性者7例(46.7%);应用实时荧光PCR法对肝脏活检组织进行检测,CMV DNA阳性病例6例(40%),其中CMV-IgM(ELISA法)与CMV DNA(RT-PCR法)均阳性4例,均阴性6例.在9例同期尸检婴儿肝脏组织中,1例CMV DNA阳性,阳性率为11.1%,明显低于胆道闭锁患儿的巨细胞病毒感染率.结论巨细胞病毒感染可能在部分胆道闭锁的发病机制中起重要作用.     

CMV感染病儿实时荧光定量PCR检测及意义

目的 探讨实时荧光定量PCR法检测病儿尿液中巨细胞病毒(CMV)-DNA含量在诊断和动态监测CMV感染中的意义.方法 应用PE 5700全自动PCR扩增分析仪,检测35例临床高度怀疑有CMV感染病儿(病儿组)尿液中的CMV-DNA拷贝数,随机选择45例同年龄段患非感染性疾病病儿作为对照组,比较两组CMV阳性标本中CMV-DNA含量,并测定治疗后的病毒载量.同时与血清CMV-IgM抗体检测结果进行比较.对部分病儿进行临床观察和随访.结果 病儿组CMV感染27例,阳性检出率为77.14%;对照组CMV感染12例,阳性检出率为26.67%.治疗后两组病儿尿液中CMV-DNA拷贝数下降幅度均较大,与治疗前比较, 差异有显著性(t=4.159、5.438,P<0.01).实时荧光定量PCR法CMV阳性检出率高于血清CMV-IgM检测方法.9 例病儿随访2年,1例胆管闭锁病儿手术后CMV病毒载量仍在较高水平,1年后发展为肝硬化;4例CMV 肝炎经治疗后, 1 例CMV-DNA转阴,3例仍阳性;4例无症状性感染病儿CMV-DNA转阴或降至低水平.结论 实时荧光定量PCR技术检测CMV感染具有快捷、灵敏度高、特异度高等优点,量化结果便于对治疗过程进行连续监测,为病儿治疗和随访提供有效帮助.     

血浆巨细胞病毒多聚酶链反应检测用于指导干预性治疗

目的：分析用血浆巨细胞病毒（cytomegalovirus,CMV)多聚酶链反应（plymerase chain reaction,PCR)检测结果指导抗CMV干预性治疗的临床意义。方法：1999年8月至2001年7月行异基因造血干细胞移植（hematopoietic stem cell transplantation,HSCT)的所有患者自预处理开始，常规用PCR法检测血浆的CMV－DNA（采用华美公司生产的巨细胞病毒4℃ PCR检测试剂盒），每周1次。其中尚无CMV病的临床表现而检测到血浆CMV阳性的患者89例。随机选取52例阳性患者给予干预性治疗。将上述89例患者分为3组（分别为停止治疗时血浆CMV－PCR转阴组、停止治疗时未转阴组、血浆CMV阳性未治疗组）比较各组CMV病的发生率。CMV病的发生率采用Kaplan-Meier曲线表示，曲线间的比较用Log-Rank（曲线无交叉）或Breslow（曲线交叉）检验，某时点率的比较采用RXC列联表或χ^2检验。结果：100d内CMV病的发生率，在治疗后血浆CMV－PCR由阳性转为阴性组为10．26％，治疗结束时血浆CMV－PCR仍为阳性组为66.67%，血浆CMV－PCR阳性未治疗组为36．24％（P＝0.0000)。上述3组中任两组移植后100d CMV病的发生率差异均有显著性。移植后1年时上述3例CMV病累积发生率分别为30.65%、75.00%、42.95%(P=0.0009)，治疗未转阴组与治疗转阴组和阳性未治疗组相比，CMV病的发生率明显升高。结论：血浆CMV－PCR检测结果用来指导干预性治疗有一定临床意义。干预性治疗后血浆CMV－DNA仍未转阴者，应考虑换药或联合用药治疗。     

抗巨细胞病毒治疗对获得性免疫缺陷综合征合并巨细胞病毒血症患者外周血凋亡相关因子水平的影响

目的  探讨抗巨细胞病毒（CMV）治疗对获得性免疫缺陷综合征（简称艾滋病）合并CMV血症患者的外周血凋亡相关因子水平的影响。方法  选取2014年1月1日～12月31日中国医科大学附属第一医院确诊住院的外周血CMVIgG阳性的男性艾滋病患者（CD4+ T<200个/μl）共34例（排除合并CMV视网膜炎者）。非随机对照分为3组,阴性CMV血症组（n =11）、阳性CMV血症非抗CMV组（n =11）、阳性CMV血症抗CMV组（n =12）。同时设立性别、年龄匹配的12例健康人做对照。同时全部入组患者于第3周末接受高效抗逆转录病毒治疗。在随访12月末时,评价各组CD4+T细胞计数、CMV视网膜炎的发生率;评价外周血凋亡相关因子浓度的变化及组间差异。结果  与健康对照比较,艾滋病患者Fas、FasL、TRAIL、TNF-α水平升高（t =-3.369、-2.683、-4.321和-5.321,P =0.012、0.033、0.009和0.003）,而Bcl-2水平降低（t =-4.321,P =0.001）。基线时3组年龄、HIVRNA载量、CD4+T细胞计数、WHO临床分期差异无统计学意义;非抗CMV组与抗CMV组CMVDNA载量差异无统计学意义。与非抗CMV组比较,抗CMV组与阴性CMV血症组12个月时CD4+T细胞计数升高（F =4.260,P =0.013和0.020）;外周血Bcl-2（F =3.621,P =0.009和0.006）、FasL（F =2.891,P = 0.024和0.002）、TNF-α浓度降低（F =4.912,P =0.003和0.001）;而抗CMV组与阴性CMV血症组组间未见差异。与基线水平比较,艾滋病患者随访12个月时Fas、FasL和TRAIL水平下降（t =2.579、2.194和2.274,P =0.015、0.035和0.030）。观察期内无CMV视网膜炎发生,无死亡病例,无HIV病毒学反弹发生。结论  抗CMV治疗促进艾滋病合并CMV血症患者的CD4+T细胞计数增长,这可能与外周血Bcl-2、FasL和TNF-α浓度降低有关。此外,高效抗逆转录病毒治疗本身也可以降低Fas、FasL和TRAIL水平。

     

小儿巨细胞病毒肺炎31例临床分析

目的:探讨小儿巨细胞病毒(CMV)肺炎的临床特点、实验室检查及治疗方法。方法:回顾性分析小儿巨细胞病毒肺炎的临床资料。结果:小儿CMV肺炎以小婴儿发病多见,多以咳喘(90.3%)为首发症状就诊,且病程较长,病情较重,多为间质性肺炎,常合并肺外表现,尿荧光定量聚合酶链反应阳性。31例均给与更昔洛韦(GCV)治疗,24例治愈7例好转。结论:小儿CMV肺炎临床表现缺乏特异性;荧光定量聚合酶链反应检测尿液保巨细胞病毒简单蜴插,具有高灵敏性;GCV是治疗婴儿CMV感染的首选药物。     

巨细胞病毒性视网膜炎

巨细胞病毒(cytomegalovirus,CMV)性视网膜炎是人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染／获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS,艾滋病)患者最常见的眼部机会性感染,是HIV相关性眼病引起视力丧失的最主要原因,多发生于CD4^ T淋巴细胞计数＜50／mm^3的患者。本文就CMV视网膜夹的发病情况、临床特点、并发症、鉴别诊断和治疗的研究进展进行综述。     

Cytomegalovirus retinitis in the era of highly active antiretroviral therapy

A number of striking changes have occurred recently in the presentation and course of cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome (AIDS) who are receiving highly active antiretroviral therapy (HAART). Before the use of HAART, CMV retinitis was the most common intraocular infection in patients with AIDS, occurring in up to 40% of patients, typically when CD4+ cell counts have decreased to less than 0.10 x 10(9)/L. By studying CMV retinitis, clinicians can investigate whether the rejuvenated immune system that results from HAART can effectively control opportunistic infections in patients with AIDS. In some patients, retinitis has not progressed when specific anti-CMV therapy was discontinued, but a number of patients have developed substantial intraocular inflammation, which has resulted in decreased visual acuity. Anterior uveitis, cataract, vitritis, cystoid macular edema, epiretinal membrane, and disc edema may occur in patients with CMV retinitis who have experienced HAART-associated elevation in CD4+ cell counts. Since immune recovery uveitis does not occur in eyes without CMV retinitis, the ocular inflammation appears to be related to the CMV infection. Anti-CMV maintenance therapy likely can be safely discontinued in some patients with CMV retinitis if CD4+ cell counts are stable or increasing and have been higher than 0.10 x 10(9)/L for at least 3 months. Immune recovery in patients receiving HAART has been effective in controlling opportunistic infections, but it may also result in intraocular inflammation, which can have adverse effects on the eye.     

Cytomegalovirus retinitis in patients with acquired immune deficiency syndrome

Cytomegalovirus (CMV) retinitis is the most common intra-ocular infection in patients with acquired immune deficiency syndrome (AIDS), and a leading cause of AIDS-related morbidity. Untreated CMV retinitis in AIDS patients is a progressive and potentially blinding disorder. The diagnosis of CMV retinitis is a clinical one and it is important for physicians to be familiar with the clinical features of the disease. Ophthalmic screening of AIDS sufferers should be undertaken at regular intervals, and this is dictated, in part, by the patient's CD4+ T-lymphocyte (CD4) counts. CMV retinitis may be treated with systemic ganciclovir, foscarnet or cidofovir, or with local (intravitreal) therpy. CMV-related retinal detachment is treated surgically. In some patients with quiescent CMV retinitis receiving highly active anti-retroviral therapy, anti-CMV maintenance therapy may be discontinued in favour of close ophthalmologic observation and CD4 count monitoring.     

艾滋病抗病毒治疗的研究进展

目的：探讨艾滋病抗病毒治疗最新的进展。方法：查阅国内外有关艾滋病抗病毒治疗的文献和综述加以总结。结果：艾滋病经高效抗逆转录病毒治疗(HAART)后HIV／AIDS病人的免疫力可以恢复，并能够对抗机会性感染。结论：艾滋病抗病毒治疗，可以延长病人的生命和提高病人的生存质量，人们开始考虑艾滋病治愈的可能性。     

The changing pattern of cytomegalovirus retinitis in human immunodeficiency virus disease

There have been profound changes in the pattern of cytomegalovirus (CMV) retinitis over the last two decades. The epidemiology and behaviour of CMV retinitis has been significantly altered by Acquired Immune Deficiency Syndrome (AIDS). It was uncommon prior to the AIDS epidemic, but soon became the most common retinal infection in AIDS patients. In the past several years, highly active anti-retroviral treatment (HAART) has achieved a dramatic improvement in the prognosis for patients infected with human immunodeficiency virus (HIV). As a result, HIV patients are living longer and have a reduced risk of CMV retinitis. Some patients with CMV retinitis who respond to HAART develop a transient symptomatic vitritis while others undergo no reactivation of their retinitis despite having no specific anti-CMV therapy. This pattern is likely to undergo further change as the treatment of HIV and CMV disease continues to improve.     

Cytomegalovirus retinitis associated with acquired immunodeficiency syndrome

Background  Cytomegalovirus (CMV) retinitis is the most severe intraocular complication that results in total retinal destruction and loss of visual acuity in patients with acquired immunodeficiency syndrome (AIDS). This study aimed to investigate the fundus characteristics, systemic manifestations and therapeutic outcomes of CMV retinitis associated with AIDS.

Methods  It was a retrospective case series. CMV retinitis was present in 39 eyes (25 patients). Best corrected visual acuities, anterior segment, fundus features, fundus fluorescence angiography (FFA) and CD4⁺ T-lymphocyte counts of the patients with CMV retinitis associated with AIDS were analyzed. Intravitreal injections of ganciclovir (400 µg) were performed in 4 eyes (2 patients).

Results  Retinal vasculitis, dense, full-thickness, yellow-white lesions along vascular distribution with irregular granules at the border, and hemorrhage on the retinal surface were present in 28 eyes. The vitreous was clear or mildly opaque. Late stage of the retinopathy was demonstrated in 8 eyes characterized as atrophic retina, sclerotic and attenuated vessels, retinal pigment epithelium (RPE) atrophy, and optic nerve atrophy. Retinal detachment was found in 3 eyes. The average CD4⁺ T-lymphocyte count in peripheral blood of the patients with CMV retinitis was (30.6±25.3) ×10⁶/L (range, (0–85) ×10⁶/L). After intravitreal injections of ganciclovir, visual acuity was improved and fundus lesions regressed.

Conclusions  CMV retinitis is the most severe and the most common intraocular complication in patients with AIDS. For the patients with yellow-white retinal lesions, hemorrhage and retinal vasculitis without clear cause, human immunodeficiency virus (HIV) serology should be performed. Routine eye examination is also indicated in HIV positive patients.

     

Highly active antiretroviral therapy per se decreased mortality and morbidity of advanced human immunodeficiency virus disease in Hong Kong

Background Morbidity and mortality of advanced human immunodeficiency virus infection (HIV) have declined in Western industrialized countries since the availability of highly active antiretroviral therapy (HAART). It is unclear if this has also happened in Hong Kong.Methods We studied a retrospective cohort of patients with advanced HIV disease in Hong Kong, China. First, the mortality of advanced HIV disease per year was calculated for the decade 1993 to 2002, both annually and according to patient observation before and after 1997. Second, the event rates were estimated for the clinical end points of acquired immune deficiency syndrome (AIDS) and death. Univariate and multivariate analyses were then performed to identify associated factors. Results The crude mortality of advanced HIV disease declined from 10.8-30.4 per 100 patients during 1993-1996, to 0.8-6.9 per 100 patients during 1997-2002. A rate ratio of 4.04 (95% CI, 2.52-6.47) was evident for those observed in 1993-1996, compared to those in 1997-2002. In a multivariate analysis where calendar period was adjusted, use of highly active antiretroviral therapy was associated with rate ratios of 0.13 (95% CI, 0.05-0.33) for death after AIDS, 0.08 (95% CI, 0.04-0.19) for AIDS after a CD4 cell count &lt;200/μl, and 0.21 (95% CI, 0.07-0.67) for death after CD4 cell count &lt;200/μl. In the same analysis, calendar period ceased to be a significant factor after adjustment for use of HAART.Conclusions The mortality and morbidity of advanced human immunodeficiency virus disease have declined in Hong Kong. This improved prognosis was attributable to the use of highly active antiretroviral therapy.